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The Prescribers

Medicare’s failure to monitor what doctors are prescribing has wasted billions of taxpayer dollars on excessive use of brand-name medication and exposed the elderly and disabled to drugs they should avoid.

A massage therapist works on the shoulder of a patient in Lakewood, Colo. Massage therapists, athletic trainers, interpreters and others who aren't allowed to write prescriptions apparently issued at least 417,000 under Medicare. (John Moore/Getty Images)

Hundreds
of thousands of times each year, Medicare pays for prescriptions purportedly
written by massage therapists, athletic trainers, interpreters and others who
aren’t allowed to prescribe drugs, according to a new federal report.

The
study released today by the inspector general of the U.S.
Department of Health and Human Services, identified more than 417,000 such prescriptions
paid for by Medicare’s prescription drug program in 2009. The tally
included initial prescriptions and refills dispensed by pharmacies.

The
inspector general found nearly 30,000 prescriptions for painkillers and other
easily abused drugs that appeared to be prescribed by individuals who had no
authority to do so. Such
prescribing could “endanger patients” and “may also contribute to the
prescription drug abuse problem in our nation,” the report said.

The cost of all the questionably prescribed drugs came to
$31.6 million, according to the study. Although just a small fraction of total
drug spending in the program, known as Part D, it raises questions about how
closely Medicare tracks the validity of prescriptions or investigates those
that appear suspicious.

“In a prescription drug program like Part D, $31 or $32 million may
not sound like a lot, but every little bit adds up,” said Sen. Tom Carper, D-Del.,
chairman of the Senate Homeland Security and Governmental Affairs. “We don’t
have the money in Medicare to be wasting for this area.”

Carper’s panel has scheduled a hearing this afternoon on prescription abuses in the program, which
cost the government $62 billion last year.

The report is the second in days in which the inspector general faulted
Medicare for its lax oversight of the program. On Thursday, the IG said it had identified more than 700 doctors with highly questionable and potentially
dangerous prescribing patterns and called on Medicare to do more to investigate
them.

It was not clear from the new report whether the drugs were
actually prescribed by the massage therapists and others or if a pharmacy had
mistakenly attributed drugs to them that were legitimately prescribed by
others. Another possible explanation is that the prescriptions were fraudulent.

The inspector general identified prescribers and their specialties
using a federal database that includes unique identification numbers, addresses
and practice information reported by providers, including their primary
specialties.

Analysts tried to exclude those who may have had authority to
prescribe drugs despite appearances. For example, someone who identified
himself or herself primarily as a dietician also may be a licensed physician.

In its response to the study, the Centers for Medicare and
Medicaid Services (CMS) said some of the examples cited by the report may be
due to weaknesses in the federal database relied upon by the inspector general.
CMS said it is working to shore up the database, but noted it relies on health
professionals to keep their information up-to-date.

Even so, the agency said it would ask its fraud contractor to
examine the issue and it would investigate the examples found by the inspector
general.

“We have already launched several efforts to address these
vulnerabilities, such as an intervention program in an area of high drug abuse
and better data analyses to detect patterns of fraud and abuse,” an agency spokesman
said in an email to ProPublica. “We agree with the OIG recommendations and are
evaluating next steps to continue improving our oversight of Part D.”

The
inspector general’s office said its analysts did not contact providers to ask
if they had actually prescribed the drugs.

The
report highlights, but doesn’t name, a Florida dietician as having ordered
about 2,600 prescriptions for 165 patients.

ProPublica
used Medicare data it had previously obtained to identify a Florida dietician
with a similar tally in 2009, the same year studied by the inspector general. Rocio Garcia, a dietician at Jackson Memorial Hospital in Miami,
said she’s never prescribed a drug: “I can’t. I’m not a doctor.”

“I
don’t know what to make of this,” Garcia said. “How could they link my name to [the
prescriptions] if I’m not a doctor?”

To
make sure that payments are accurate, the inspector general said Medicare
should require the private insurers that administer Part D to verify that a
provider has authority to prescribe drugs before paying for them.

7 comments

The U.S. spends $300 billion a year on prescription drugs and you are publishing an article about $31 million, one-one hundredth of one percent of the total.

Medicare does an outstanding job of controlling costs and negotiating prices, even though they are not allowed to do that by a lobbyist-driven Congress with prescription drugs.

Some emphasis on $10,000 single dose drugs paid for in the private sector would seem more towering an issue than the anthill you are using to justify what - privatizing Medicare to please the plutocrats behind that crusade?

how bout simply not paying for Rx’s that are not valid. why bother investigating etc. If the govt cant come up with a simple system to pay for only what they are supposed to pay for then they should simply get out of the business of paying for any of it. They are inept and costing the tax payer.

How can this be without a valid prescriber ID number? Unless something has changed in the field of Pharmacy in the years since I worked there? I am still a CPhT and I know how to validate ID numbers and prescribers. It is part of the job or are the pharmacies dropping the ball? they could just be fraud and be prosecuted to the full extent of the law. Send a few to jail or hurt their pocket books or both and it will end pretty much.

Putting stronger penalties into law for Medicare fraud commited by doctors and hospitals ie jail time for offenders*) for far to long many offenders have beenb ,confederate republicans,with some liberals in there to ,have been getting away with slaps on the wrists.the fraud and most loopholes just like the taxhavens and anti tax confederate republicans take advantage of this system they are against and want to give control to wallstreet and cronies,by crying ineptness on the governments part in running programs is in their self interest and not as Americas or its taxpayers interests. Just as all government the confederates look to change and control for their interests not that of the ass American people.

This is a result of a very complex computer system which somehow can still be hacked. There have been anomalies in the systems and although small, can lead to big losses in the long run. I suggest that they make their systems stronger and hack-free.

Commenting on this story is closed.

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Medicare’s failure to monitor what doctors are prescribing has wasted billions of taxpayer dollars on excessive use of brand-name medication and exposed the elderly and disabled to drugs they should avoid.

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